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Chung RJ, Lee JB, Hackell JM, Alderman EM. Confidentiality in the Care of Adolescents: Technical Report. Pediatrics 2024; 153:e2024066327. [PMID: 38646698 DOI: 10.1542/peds.2024-066327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/23/2024] [Indexed: 04/23/2024] Open
Abstract
Confidentiality is a foundational element of high-quality, accessible, and equitable health care. Despite strong grounding in federal and state laws, professional guidelines, and ethical standards, health care professionals and adolescent patients face a range of complexities and barriers to seeking and providing confidential care to adolescents across different settings and circumstances. The dynamic needs of adolescents, the oftentimes competing interests of key stakeholders, the rapidly evolving technological context of care, and variable health care billing and claims requirements are all important considerations in understanding how to optimize care to focus on and meet the needs of the adolescent patient. The following assessment of the evolving evidence base offers a view of the current state and best practices while pointing to numerous unmet needs and opportunities for improvement in the care experiences of youth as well as their health outcomes.
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Affiliation(s)
- Richard J Chung
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina
| | - Janet B Lee
- Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Jesse M Hackell
- Department of Pediatrics, New York Medical College, Valhalla, New York
| | - Elizabeth M Alderman
- Division of Adolescent Medicine, Department of Pediatrics, Albert Einstein College of Medicine and The Children's Hospital at Montefiore, Bronx, New York
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Peng W, Huang Q, Mao B. Evaluating variations in the barriers to colorectal cancer screening associated with telehealth use in rural U.S. Pacific Northwest. Cancer Causes Control 2024; 35:635-645. [PMID: 38001334 DOI: 10.1007/s10552-023-01819-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 10/22/2023] [Indexed: 11/26/2023]
Abstract
PURPOSE The incidence and mortality rates of colorectal cancer (CRC) remain consistently high in rural populations. Telehealth can improve screening uptake by overcoming individual and environmental disadvantages in rural communities. The present study aimed to characterize varying barriers to CRC screening between rural individuals with and without experience in using telehealth. METHOD The cross-sectional study surveyed 250 adults aged 45-75 residing in rural U.S. states of Alaska, Idaho, Oregon, and Washington from June to September 2022. The associations between CRC screening and four sets of individual and environmental factors specific to rural populations (i.e., demographic characteristics, accessibility, patient-provider factors, and psychological factors) were assessed among respondents with and without past telehealth adoption. RESULT Respondents with past telehealth use were more likely to screen if they were married, had a better health status, had experienced discrimination in health care, and had perceived susceptibility, screening efficacy, and cancer fear, but less likely to screen when they worried about privacy or had feelings of embarrassment, pain, and discomfort. Among respondents without past telehealth use, the odds of CRC screening decreased with busy schedules, travel burden, discrimination in health care, and lower perceived needs. CONCLUSION Rural individuals with and without previous telehealth experience face different barriers to CRC screening. The finding suggests the potential efficacy of telehealth in mitigating critical barriers to CRC screening associated with social, health care, and built environments of rural communities.
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Affiliation(s)
- Wei Peng
- Edward R. Murrow College of Communication, Washington State University, Murrow Hall 211, Pullman, WA, 99164, USA.
| | - Qian Huang
- Department of Communication, University of North Dakota, Grand Forks, ND, USA
| | - Bingjing Mao
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
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3
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Allison BA, Yates L, Tadikonda A, Arora KS, Stuart GS. Single-Visit Long-Acting Reversible Contraception Initiation Among Adolescents Before and During COVID-19. J Adolesc Health 2024; 74:367-374. [PMID: 37815761 PMCID: PMC10810361 DOI: 10.1016/j.jadohealth.2023.08.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 07/28/2023] [Accepted: 08/21/2023] [Indexed: 10/11/2023]
Abstract
PURPOSE Single-visit long-acting reversible contraception (LARC) is cost-effective and convenient. Our objective was to compare incidence of single-visit LARC placement and associated factors during the year before the COVID-19 pandemic (March 15, 2020) and the first year of the pandemic. METHODS This retrospective cohort study analyzed electronic health records from a large healthcare system. Eligible adolescents were aged 10-19 years and received outpatient LARC from March 15, 2019 to March 14, 2021. Logistic regression models determined the relationship of patient and provider characteristics on single-visit LARC before and during COVID-19. RESULTS One thousand six adolescents initiated LARC during the study period. Fewer adolescents received single-visit LARC during COVID-19 (289/506, 57.1%) compared to before (315/500, 63.0%), although changes in odds of single-visit LARC were not statistically significant. Concordance between county of patient residence and the location of the LARC placement facility was associated with single-visit LARC before (adjusted odds ratio [aOR] = 2.75) and during (aOR = 1.74) the pandemic (both p < .05). During the pandemic, a few factors were associated with reduced odds of single-visit LARC: (1) public insurance (aOR = 0.49, p < .01), (2) nonobstetricians/nongynecologists providers (pediatrics [aOR = 0.35, p < .01], family medicine [aOR = 0.53, p < .01], or internal medicine [aOR = 0.14, p < .05]), and (3) advanced practice practitioners (aOR = 0.49, p < .01). DISCUSSION Incidence of single-visit LARC was similar before and during the pandemic. Certain factors were associated with lower odds of single-visit LARC insertion, suggesting differential access during the pandemic for subgroups of adolescents. Our findings may guide policy and programmatic interventions to improve access to single-visit LARC for all adolescent populations.
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Affiliation(s)
- Bianca A Allison
- Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, North Carolina.
| | - Lindsey Yates
- Department of Maternal and Child Health, Center of Excellence, Gillings School of Global Public Health, Chapel Hill, North Carolina
| | - Ananya Tadikonda
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Kavita Shah Arora
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Gretchen S Stuart
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
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Yankappa N, Kumar A, Prasad A, Tiwari L, Kumar P. Clinicodemographic Profile and Clinical Outcome of Children Presenting to Telemedicine Center at Institute of National Importance of India: A Prospective Observational Study. Int J Telemed Appl 2024; 2024:5341988. [PMID: 38327874 PMCID: PMC10849814 DOI: 10.1155/2024/5341988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 01/16/2024] [Accepted: 01/18/2024] [Indexed: 02/09/2024] Open
Abstract
Background There is a global shortage of healthcare professionals, especially in developing countries, leading to disparities in access to healthcare, worsened by the pandemic. Telemedicine is emerging as a solution, with growing adoption worldwide due to advancements in technology and increased awareness. Research Problem. The establishment of telemedicine depends on resources, infrastructure, and knowledge about healthcare needs. Further studies are needed to monitor and address evolving issues in telemedicine. The Overall Purpose of the Study. Rural health disparities stem from multiple factors, like limited healthcare access, workforce shortages, lifestyle choices, and lower socioeconomic status, leading to higher mortality and chronic diseases. Addressing these challenges is vital for rural community well-being. Telemedicine centers present a promising solution, bridging gaps, and improving healthcare outcomes for underserved remote populations. Methodology. Objective: This study assessed the clinicodemographic profile and clinical outcome of children presenting to the telemedicine center at the Institute of National Importance in India. Design: Prospective observational study. Setting: A single-center tertiary care level. Participants: This study included 79 children aged up to 18 years. Major Findings and Summary of Interpretations. In our study, 79 children using telemedicine found a near-equal gender distribution. 8.9% needed emergency care, with common complaints being respiratory issues, fever, abdominal pain, and vomiting. After two weeks, 83.5% showed improvement, emphasizing telemedicine's effectiveness in pediatric care. Conclusion Our study underscores telemedicine's positive impact on pediatric healthcare, emphasizing its potential to enhance access, outcomes, and cost-efficiency. Wider telemedicine adoption can reduce morbidity and mortality, support preventive care, and streamline posttreatment services, alleviating pressure on specialized facilities. While our focus was pediatrics, the telemedicine model is adaptable to various age groups and conditions, but it should be seen as a valuable supplement to, not a total substitute for, in-person healthcare visits.
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Affiliation(s)
- N. Yankappa
- Department of Paediatrics, All India Institute of Medical Sciences, Patna, India
| | - Anil Kumar
- Department of Trauma Surgery & Critical Care, All India Institute of Medical Sciences, Patna, India
| | - Arun Prasad
- Department of Paediatrics, All India Institute of Medical Sciences, Patna, India
| | - Lokesh Tiwari
- Department of Paediatrics, All India Institute of Medical Sciences, Patna, India
| | - Pradeep Kumar
- Department of Paediatrics, All India Institute of Medical Sciences, Patna, India
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Danielson CK, Moreland A, Hahn A, Banks D, Ruggiero KJ. Development and Usability Testing of an mHealth Tool for Trauma-Informed Prevention of Substance Use, HIV Acquisition, and Risky Sexual Behaviors Among Adolescents: Mixed Methods Study. JMIR Form Res 2024; 8:e52835. [PMID: 38236634 PMCID: PMC10835591 DOI: 10.2196/52835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 11/14/2023] [Accepted: 11/28/2023] [Indexed: 01/19/2024] Open
Abstract
BACKGROUND Youth who experience traumatic events are at a substantially higher risk of engaging in substance use and sexual risk behaviors and problems (eg, HIV acquisition) than their non-trauma-exposed counterparts. Evidence-based substance use and risky sexual behavior prevention may reduce the risk of these outcomes. Trauma-focused mental health treatment provides a window of opportunity for the implementation of such preventive work with these youth. However, overburdened clinicians face challenges in adding prevention content while implementing evidence-based treatments. Mobile health (mHealth) tools can help reduce this burden in delivering prevention curricula. Trauma-Informed Prevention for Substance Use and Risky Sexual Behavior (TIPS) is an mHealth app that was developed to aid trauma-focused cognitive behavioral therapy (TF-CBT) clinicians in the implementation of an evidence-based risk behavior prevention curriculum. OBJECTIVE The goal of this paper is to describe the rationale for and development of the TIPS app and present the results of a mixed methods approach for the initial evaluation of its usability. METHODS Participants included clinicians (n=11), adolescents (n=11), and caregivers (n=10) who completed qualitative interviews and an adapted version of the Website Analysis and Measurement Inventory. RESULTS In total, 4 overarching themes emerged from the participants' answers to the qualitative interview questions, demonstrating a generally positive response to the app. The themes were (1) strength of app content, (2) suggestions about app content, (3) esthetics and usability, and (4) benefits to the patient and session implementation. Clinicians, adolescents, and caregivers all agreed that the content was very relevant to adolescents and used examples and language that adolescents could relate to. All 3 groups also discussed that the content was comprehensive and addressed issues often faced by adolescents. All 3 groups of users made suggestions about the esthetics, which mostly comprised suggestions to change the font, color, or pictures within the app. Of all the groups, adolescents were most positive about the esthetics and usability of the app. Results from the Website Analysis and Measurement Inventory further illustrated the users' favorable reaction to the TIPS app, with 100% (11/11) of clinicians, 100% (10/10) of caregivers, and most adolescents (7/11, 64%) selecting strongly agree or somewhat agree to the following statement: "This app has much that is of interest to me." Adolescents generally found the app easier to use than did caregivers and clinicians. CONCLUSIONS The TIPS app shows promise as an mHealth tool for TF-CBT clinicians to integrate evidence-based substance use, risky sexual behavior, and HIV prevention during treatment. Future research, including a randomized controlled trial comparing TF-CBT implementation with and without the inclusion of the app, is necessary to evaluate the feasibility and efficacy of the app in reducing the risk of substance use and risky sexual behavior among trauma-exposed adolescents. TRIAL REGISTRATION ClinicalTrials.gov NCT03710720; https://clinicaltrials.gov/study/NCT03710720.
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Affiliation(s)
- Carla Kmett Danielson
- Department of Psychiatry & Behavioral Science, Medical University of South Carolina, Charleston, SC, United States
| | - Angela Moreland
- Department of Psychiatry & Behavioral Science, Medical University of South Carolina, Charleston, SC, United States
| | - Austin Hahn
- Department of Psychiatry & Behavioral Science, Medical University of South Carolina, Charleston, SC, United States
| | - Devin Banks
- Department of Psychology, University of Missouri-Saint Louis, Saint Louis, MO, United States
| | - Kenneth J Ruggiero
- College of Nursing, Medical University of South Carolina, Charleston, SC, United States
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Conroy K, Kehrer SM, Georgiadis C, Hare M, Ringle VM, Shaw AM. Learning from Adolescents and Caregivers to Enhance Acceptability and Engagement Within Virtual Dialectical Behavior Therapy for Adolescents Skills Groups: A Qualitative Study. Child Psychiatry Hum Dev 2024:10.1007/s10578-023-01641-7. [PMID: 38183575 DOI: 10.1007/s10578-023-01641-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/14/2023] [Indexed: 01/08/2024]
Abstract
Despite the significant increase in adolescent mental health challenges in recent years, structural barriers continue to limit access to and engagement in mental health services. As such, opportunities to learn directly from adolescents and their families on how to best structure and deliver services are paramount. The current study assumes a multi-informant approach and reports on adolescents' and caregivers' (N = 33) experiences in an adapted telehealth/hybrid Dialectical Behavior Therapy for Adolescents (DBT-A) program. Focus groups were conducted across two cohorts of families who participated in DBT-A skills groups, to collect family-centered data on the acceptability of program modifications, engagement in the adapted telehealth/hybrid DBT-A, and recommendations for improvement. Participants were predominately Latine White and were from a broad range of socioeconomic backgrounds. Additionally, 45.5% of the adolescents identified as LGBTQ + . Focus group findings emphasized how the telehealth platform was both convenient and disengaging, and how in-person sessions offered improved group connection and content engagement. Participants underscored the importance of balancing multi-family group sessions with adolescent- and caregiver-only group sessions in the program, and adolescents emphasized a need for the DBT-A program to better center adolescents' unique experiences and voices throughout sessions. Both adolescents and caregivers suggested modifications to synthesize the content and improve generalizability of the DBT-A skills to their real lives. Overall, these findings add to a new and evolving branch of DBT-A qualitative inquiry, as well as the growing body of work that recommends incorporating the voices of people with lived experiences into the development and modification of psychological services.
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Affiliation(s)
- Kristina Conroy
- Center for Children and Families, Department of Psychology, Florida International University, Miami, FL, USA.
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.
| | - Sabrina M Kehrer
- Center for Children and Families, Department of Psychology, Florida International University, Miami, FL, USA
| | - Christopher Georgiadis
- Center for Children and Families, Department of Psychology, Florida International University, Miami, FL, USA
- The Warren Alpert Medical School, Department of Psychiatry, Brown University, Providence, RI, USA
| | - Megan Hare
- Department of Psychiatry and Behavioral Sciences, Tulane University School of Medicine, New Orleans, LA, USA
- Department of Psychology and Human Development, Vanderbilt University, Nashville, TN, USA
| | - Vanesa Mora Ringle
- Counseling Psychology Program, Department of Education and Human Services, Lehigh University, Bethlehem, PA, USA
| | - Ashley M Shaw
- School of Social and Behavioral Sciences, University of New England, Biddeford, ME, USA
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Reilly K, Ebersole A. Confidentiality and privacy considerations for adolescents receiving contraceptive health services via telemedicine: A narrative review. WOMEN'S HEALTH (LONDON, ENGLAND) 2024; 20:17455057241233126. [PMID: 38424665 PMCID: PMC10908226 DOI: 10.1177/17455057241233126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 12/21/2023] [Accepted: 01/25/2024] [Indexed: 03/02/2024]
Abstract
Confidential medical care for adolescent patients is essential as they are likely to forgo needed care if privacy cannot be maintained. The use of telemedicine for adolescent health has rapidly expanded due to the COVID-19 pandemic and can increase access to important services like reproductive care; however, it has raised challenges for providers, patients, and their parents/guardians related to confidentiality and privacy. Health care providers are often uncertain about the laws and regulations that govern confidential services including the 21st Century Cures Act. Through a narrative review of studies on confidentiality and telemedicine, this article seeks to summarize the available evidence and provide recommendations on maintaining privacy during virtual encounters and identify current best practices for prescribing contraception via telemedicine.
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Affiliation(s)
| | - Ashley Ebersole
- The Ohio State University College of Medicine, Division of Adolescent Medicine, Nationwide Children’s Hospital, Columbus, OH, USA
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Mikesell L, Rea S, Cuddihy C, Perry M, Allison B. Exploring the Connectivity Paradox: How the Sociophysical Environment of Telehealth Shapes Adolescent Patients' and Parents' Perceptions of the Patient-Clinician Relationship. HEALTH COMMUNICATION 2023; 38:2854-2864. [PMID: 36102361 DOI: 10.1080/10410236.2022.2124056] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Even before the widespread transition to telehealth as a result of COVID-19, there was a considerable amount of research exploring its value and impact. However, telehealth research with adolescent patients is somewhat limited, with most work focusing on access, feasibility, and acceptability but reporting far less frequently on relationship building and rapport. This study examines qualitative interviews with adolescent patients (n = 14) and parents (n = 20) from a larger convergent parallel mixed methods study to explore how they understand telehealth to have altered the sociophysical environment of primary care clinic encounters and whether they perceive these changes to influence adolescents' relationships with clinicians. We show that participants perceived the sociophysical environment of telehealth to be both less institutional (e.g. more relaxed and less rushed) and more instrumental (e.g. more focused on the chief complaint), which shaped interactions with clinicians in ways that were experienced as paradoxically less personal (e.g. lacking social connection) and more person-centered (e.g. more attentive to the individual patient). We discuss theoretical and practical implications of these findings and what they mean for defining person-centered communication for adolescent care.
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Affiliation(s)
| | - Samantha Rea
- Transitional Year Residency Program, Henry Ford Health System
| | | | - Martha Perry
- Department of Pediatrics, University of North Carolina at Chapel Hill
| | - Bianca Allison
- Department of Pediatrics, University of North Carolina at Chapel Hill
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9
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Leong R, Sanderson KE, Klassen AF, Ratcliffe EM, Zuniga-Villanueva G. Comparing the suitability of virtual versus in-person care: Perceptions from pediatricians. J Telemed Telecare 2023:1357633X231205329. [PMID: 37904516 DOI: 10.1177/1357633x231205329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2023]
Abstract
OBJECTIVES The COVID-19 pandemic compelled a portion of healthcare to be delivered virtually. As the pandemic waned, health systems strived to find a balance between re-incorporating in-person care while maintaining virtual care. To find when virtual or in-person encounters are more appropriate, we surveyed pediatricians' perceptions when comparing the suitability of virtual care to in-person care. METHODS We surveyed a Canadian tertiary-level pediatric hospital where pediatricians assessed whether specific clinical encounters or tasks were more or less effective virtually than when performed in person. Pediatricians also rated the importance of clinical and patient factors when deciding if a patient needs to be seen in person. RESULTS Of 160 pediatrics faculty members, 56 (35%) responded to the survey. When assessing different types of clinical encounters, triage, multidisciplinary meetings, discharge, and follow ups were more likely to favor virtual encounters. However, first consultations and family meetings were more likely to favor in-person encounters. Regarding clinical tasks, pediatricians were more likely to endorse explaining test results, offering treatment recommendations, and obtaining patient histories virtually. On the contrary, there was a preference for physical examinations, assessing patients visually, and assessing developmental milestones to be performed in person. When deciding if a patient should be seen in person versus virtual, pediatricians rated the patient's condition and communication barriers as the most important factors favoring an in-person appointment. DISCUSSION These results offer an initial framework for pediatricians when choosing which encounter type may be most appropriate for their patients between virtual or in-person appointments.
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Affiliation(s)
- Russell Leong
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Kate E Sanderson
- Hamilton Health Sciences Centre for Evidence-Based Implementation, McMaster University, Hamilton, ON, Canada
| | - Anne F Klassen
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | | | - Gregorio Zuniga-Villanueva
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
- Department of Pediatrics, Tecnológico de Monterrey, Monterrey, NL, Mexico
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Rose SB, Garrett SM, McKinlay E. Experience of telehealth for receipt of primary health care: an online survey of young people in a geographic region of Aotearoa New Zealand. Aust J Prim Health 2023; 29:319-326. [PMID: 36657735 DOI: 10.1071/py22073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 12/13/2022] [Indexed: 01/21/2023]
Abstract
BACKGROUND Telehealth became more widely used when the global COVID-19 pandemic restricted access to in-person consultations for primary care during periods of 'lockdown'. METHODS In 2021 (August-September), 15-to 25-year-olds in the Wellington region of Aotearoa New Zealand were invited to participate in an online survey that aimed to find out about telehealth experiences, perceived advantages and disadvantages, and willingness to use it for receipt of primary care. RESULTS Surveys were completed by 346 participants, 133 of whom had ever used telehealth (38%). Overall, 73% (84/115) were happy with health care received via telehealth, but only 26% preferred it to in-person consultations. Perceived benefits related to convenience and time efficiency, but participants had concerns about the inability to be physically examined, technological issues, clarity around follow-up actions, payment and lack of privacy. All participants had access to a phone or device, yet almost half reported challenges with connectivity, coverage or data that might limit their ability to access telehealth (47.3%, 159/336). Half of participants wanted to use telehealth in future (preferring phone over video (160/315)). CONCLUSIONS Young people surveyed acknowledged the convenience of telehealth, but many were hesitant about receiving primary care in this way. Understanding young people's reservations and provision of detailed information about what telehealth entails will help prepare and support them to use telehealth in future.
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Affiliation(s)
- Sally B Rose
- Department of Primary Health Care and General Practice, University of Otago, Wellington, PO Box 7343, Wellington South 6242, New Zealand
| | - Susan M Garrett
- Department of Primary Health Care and General Practice, University of Otago, Wellington, PO Box 7343, Wellington South 6242, New Zealand
| | - Eileen McKinlay
- Department of Primary Health Care and General Practice, University of Otago, Wellington, PO Box 7343, Wellington South 6242, New Zealand
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Rankine J, Kidd KM, Sequeira GM, Miller E, Ray KN. Adolescent Perspectives on the Use of Telemedicine for Confidential Health Care: An Exploratory Mixed-Methods Study. J Adolesc Health 2023; 73:360-366. [PMID: 37227338 PMCID: PMC10524174 DOI: 10.1016/j.jadohealth.2023.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 03/16/2023] [Accepted: 04/04/2023] [Indexed: 05/26/2023]
Abstract
PURPOSE Telemedicine can improve access to adolescent health care, but adolescents may experience barriers to accessing this care confidentially. Gender-diverse youth (GDY) may especially benefit from telemedicine through increased access to geographically limited adolescent medicine subspecialty care but may have unique confidentiality needs. In an exploratory analysis, we examined adolescents' perceived acceptability, preferences, and self-efficacy related to using telemedicine for confidential care. METHODS We surveyed 12- to 17-year-olds following a telemedicine visit with an adolescent medicine subspecialist. Open-ended questions assessing acceptability of telemedicine for confidential care and opportunities to enhance confidentiality were qualitatively analyzed. Likert-type questions assessing preference for future use of telemedicine for confidential care and self-efficacy to complete components of telemedicine visits confidentially were summarized and compared across cisgender versus GDY. RESULTS Participants (n = 88) included 57 GDY and 28 cisgender females. Factors affecting the acceptability of telemedicine for confidential care related to patient location, telehealth technology, adolescent-clinician relationships, and quality or experience of care. Perceived opportunities to protect confidentiality included using headphones, secure messaging, and prompting from clinicians. Most participants (53/88) were likely or very likely to use telemedicine for future confidential care, but self-efficacy for completing components of telemedicine visits confidentially varied by component. DISCUSSION Adolescents in our sample were interested in using telemedicine for confidential care, but cisgender and GDY recognized threats to confidentiality that may reduce acceptability of telemedicine for these services. Clinicians and health systems should carefully consider youth's preferences and unique confidentiality needs to ensure equitable access, uptake, and outcomes of telemedicine.
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Affiliation(s)
- Jacquelin Rankine
- UPMC Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
| | - Kacie M Kidd
- WVU Medicine Children's, West Virginia University School of Medicine, Morgantown, West Virginia
| | - Gina M Sequeira
- Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Washington
| | - Elizabeth Miller
- UPMC Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Kristin N Ray
- UPMC Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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12
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Barney A, Mendez-Contreras S, Hills NK, Buckelew SM, Raymond-Flesch M. Telemedicine in an adolescent and young adult medicine clinic: a mixed methods study. BMC Health Serv Res 2023; 23:680. [PMID: 37349720 DOI: 10.1186/s12913-023-09634-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 06/02/2023] [Indexed: 06/24/2023] Open
Abstract
BACKGROUND Adolescents and young adults are a diverse patient population with unique healthcare needs including sensitive and confidential services. Many clinics serving this population began offering telemedicine during the Covid-19 pandemic. Little is known regarding patient and parent experiences accessing these services via telemedicine. METHODS To assess for trends and disparities in telemedicine utilization in the first year of the pandemic, we used the electronic health record to obtain patient demographic data from an adolescent and young adult medicine clinic in a large urban academic institution. Characteristics of patients who had accessed telemedicine were compared to those who were only seen in person. Mean age was compared using t-test, while other demographic variables were compared using chi-squared test or Fisher's exact test. We performed qualitative semi-structured interviews with patients and parents of patients in order to characterize their experiences and preferences related to accessing adolescent medicine services via telemedicine compared to in-person care. RESULTS Patients that identified as female, white race, Hispanic/Latinx ethnicity were more likely to have utilized telemedicine. Telemedicine use was also more prevalent among patients who were privately insured and who live farther from the clinic. Although interview participants acknowledged the convenience of telemedicine and its ability to improve access to care for people with geographic or transportation barriers, many expressed preferences for in-person visits. This was based on desire for face-to-face interactions with their providers, and perception of decreased patient and parent engagement in telemedicine visits compared to in-person visits. Participants also expressed concern that telemedicine does not afford as much confidentiality for patients. CONCLUSIONS More work is needed to address patient and parent preferences for telemedicine as an adjunct modality to in-person adolescent and young adult medicine services. Optimizing quality and access to telemedicine for this patient population can improve overall healthcare for this patient population.
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Affiliation(s)
- Angela Barney
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, University of California, San Francisco, United States.
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, University of California San Diego, San Diego, United States.
| | | | - Nancy K Hills
- Department of Neurology, UCSF Weill Institute for Neurosciences, University of California San Francisco School of Medicine, San Francisco, United States
| | - Sara M Buckelew
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, University of California, San Francisco, United States
| | - Marissa Raymond-Flesch
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, University of California, San Francisco, United States
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, United States
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Perry MF. Confidential Telehealth Care for Adolescents: Challenges and Solutions Identified During the COVID-19 Pandemic. CURRENT PEDIATRICS REPORTS 2023; 11:1-8. [PMID: 37363323 PMCID: PMC10258077 DOI: 10.1007/s40124-023-00288-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/08/2023] [Indexed: 06/28/2023]
Abstract
Purpose of review To identify lessons learned about maintaining confidentiality for adolescent telehealth care during the COVID-19 pandemic. Recent findings Adolescents, parents, and providers recognize benefits of telehealth for confidential care while also identifying potential risks for confidentiality breach unique to the telehealth care setting. Summary Rapid implementation of telehealth care during COVID-19 presented an opportunity to test strategies that protect confidentiality for adolescents accessing care through telehealth. Policy, practice, and provider-level interventions are needed to ensure that adolescents can access confidential care through telehealth.
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Affiliation(s)
- Martha F. Perry
- Department of Pediatrics, UNC School of Medicine, Chapel Hill, NC USA
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Kodjebacheva GD, Culinski T, Kawser B, Coffer K. Satisfaction with telehealth compared to non-telehealth services among pediatric patients and their caregivers: A systematic review of the literature. JMIR Pediatr Parent 2023; 6:e41554. [PMID: 37000504 PMCID: PMC10176140 DOI: 10.2196/41554] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 11/10/2022] [Accepted: 03/27/2023] [Indexed: 04/01/2023] Open
Abstract
BACKGROUND Telehealth is the use of technology to deliver healthcare in a virtual format. The COVID-19 pandemic prompted an increase in the use of telehealth. OBJECTIVE To review satisfaction with pediatric care only in studies that have at least one group of pediatric patients and/or their caregivers receiving telehealth during the COVID-19 pandemic and at least one comparison group of those receiving non-telehealth services. METHODS We searched for peer-reviewed studies published in English that compared satisfaction with pediatric care between pediatric patients and/or their caregivers receiving telehealth services during the COVID-19 pandemic and those receiving non-telehealth services. Because of stay-at-home orders, studies with comparison groups for non-telehealth services that took place either before or during the pandemic were eligible. We conducted the search on January 5, 2023, in the PubMed, EMBASE, CINAHL, and PsycInfo databases. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Two reviewers independently screened titles and abstracts prior to reviewing the full-text of remaining articles. The following information from each eligible study was extracted: country, participant characteristics by comparison group, study design, telehealth approach, measurement tools to assess satisfaction, and findings by comparison group. RESULTS All eligible 14 studies assessed satisfaction among caregivers and/or pediatric patients participating in video and/or telephone visits during the COVID-19 pandemic compared to those having in-person appointments either prior to or during the pandemic. In 5 of the 14 studies, comparison non-telehealth services took place before the pandemic, and in the remaining 9 investigations, non-telehealth services took place during the pandemic. Thirteen studies were observational investigations with different designs and one study was a quasi-experimental intervention with 3 comparison groups for video, in-person, and hybrid visits. In 9 out of the 14 studies, satisfaction with telehealth services was higher compared to that during in-person visits. Reasons caregivers were satisfied with video visits were the ease of use and the reduced need for transportation. Reasons caregivers were not satisfied with remote care included limited personal interaction with the provider and technological challenges. Caregivers participating in telehealth expressed concerns about the lack of a physical examination. Those participating in non-telehealth services expressed that in-person interactions promoted treatment adherence. Only 1 study assessed satisfaction among patients where adolescents completed their own surveys; a higher percentage of adolescents using telehealth reported effective communication with the provider compared to patients using in-person visits. CONCLUSIONS Telehealth services tended to receive more favorable or comparable satisfaction ratings than in-person visits in most studies. Needed improvements in telehealth included strategies to address technological challenges and develop better rapport between the patient/caregiver and medical provider. Interventions on the effectiveness of pediatric telehealth compared to pediatric non-telehealth services on improving satisfaction and health outcomes will be valuable. CLINICALTRIAL
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Affiliation(s)
- Gergana Damianova Kodjebacheva
- Department of Public Health and Health Sciences, College of Health Sciences, University of Michigan-Flint, 303 E. Kearsley St., Flint, US
- International Institute, University of Michigan, Ann Arbor, US
| | - Taylor Culinski
- Department of Behavioral Sciences, College of Arts and Sciences, University of Michigan-Flint, Fint, US
| | - Bushra Kawser
- Department of Public Health and Health Sciences, College of Health Sciences, University of Michigan-Flint, 303 E. Kearsley St., Flint, US
| | - Katelynn Coffer
- Department of Public Health and Health Sciences, College of Health Sciences, University of Michigan-Flint, 303 E. Kearsley St., Flint, US
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Telehealth Use in Pediatric Care during the COVID-19 Pandemic: A Qualitative Study on the Perspectives of Caregivers. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10020311. [PMID: 36832439 PMCID: PMC9955717 DOI: 10.3390/children10020311] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 02/02/2023] [Accepted: 02/04/2023] [Indexed: 02/08/2023]
Abstract
This qualitative study surveyed caregivers regarding their perspectives on the benefits of, challenges with, and suggestions for improving telehealth during the COVID-19 pandemic. Caregivers who had the responsibility for caring for at least one child aged under 18 years of age in Genesee County, MI, participated. The caregivers were biological parents, stepparents, foster parents, adoptive parents, and guardians. A total of 105 caregivers completed a survey with open-ended questions via Qualtrics. Two independent coders developed themes based on the responses using grounded theory. Participants were primarily biological parents and non-Hispanic White and African Americans. According to the participants, the benefits of telehealth included prevention of exposure to the COVID-19 virus, quality communication with physicians, savings in travel time, and cost-effective methods to receive care. The challenges included a lack of in-person interaction, fear of compromised confidentiality, and the potential for misdiagnosis. Suggestions for improvement by caregivers included increasing access to telehealth for poorer families, offering a media educational campaign to promote telehealth use, and creating a universal platform to share patient information. Future studies may test the effectiveness of interventions such as those suggested by caregivers in this study to improve telehealth.
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Rea S, Mikesell L, Cuddihy C, Perry M, Allison B. Exploring the Complexity of Telehealth Privacy Through a Lens of Adolescent Development. QUALITATIVE HEALTH RESEARCH 2023; 33:220-235. [PMID: 36655804 DOI: 10.1177/10497323231151596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Many challenges exist related to ensuring adolescent privacy with health care providers (HCPs), and the rapid integration of telehealth visits has created additional complexities in organizing privacy for adolescents. Through interviews with adolescent patients and their parents (n = 34), this qualitative analysis aimed to explore the complicated relationship and balance of adolescent alone time with HCPs, parental presence and support, and organization of privacy in order to consider how privacy during telehealth visits may contribute to adolescents' healthy development. A framework by Blum et al. (2014) proposed four central goals of adolescent development: emotional security, engagement with learning, self-efficacy, and decision-making skills. This conceptual framework was used to outline the ways in which adolescent privacy during telehealth impacts adolescent development. Some adolescents reported that having their parents present during their telehealth visit afforded reassurance and comfort, and many parents explained that they served as a role-model during their adolescent's telehealth visit. However, other adolescents felt higher emotional security when they could establish an independent relationship with their HCP, with many describing how privacy during their telehealth visit enabled them to have more sensitive discussions with their HCP. Adolescents and parents also reported that telehealth allowed increased experiential learning for adolescents, given their proficiency with technology and ability to access their health care visits autonomously. Furthermore, the organization of privacy was complicated by a lack of understanding whose responsibility it was to facilitate alone time between the adolescent and HCP, as well as external factors such as location and quality of technology and the proximity of family members in the home. By ensuring opportunities for private healthcare encounters, both in telehealth and in-person visits, HCPs and parents can help support adolescents in achieving successful and healthy development.
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Affiliation(s)
- Samantha Rea
- 12267Wayne State University School of Medicine, Detroit, MI, USA
| | | | | | - Martha Perry
- 2332University of North Carolina System, Chapel Hill, NC, USA
| | - Bianca Allison
- 2332University of North Carolina System, Chapel Hill, NC, USA
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Martínez JA, Hijaz B, Subedi S, Boskey ER, Ganor O. Patient and parent perspectives on the utility of telemedicine for initial surgical gender care consultations: A cross-sectional survey. Digit Health 2023; 9:20552076231191619. [PMID: 37559831 PMCID: PMC10408325 DOI: 10.1177/20552076231191619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 07/13/2023] [Indexed: 08/11/2023] Open
Abstract
Introduction The COVID-19 pandemic has expanded the use of telemedicine to patient populations that were previously constrained to in-person visits. Few studies have investigated the role that telemedicine plays in shaping the care of these patient populations. This project explores the impact of telemedicine for one such population: patients and parents of gender-diverse individuals seeking gender-affirming surgery. Methods A 10-question survey using previously validated questions was completed by 34 patients and 9 parents of patients (aged 15-31) who received virtual care at the Center for Gender Surgery at Boston Children's Hospital between March 2020 and April 2021. The survey was divided into two parts. The first section collected demographic information. The second assessed participant perspectives on remote surgical gender care through a series of Likert-type and open-ended questions. Results A total of 100% of the respondents felt that their telemedicine visit was convenient; 60% (18) of the patients and 87% (7) of the parents stated that they look forward to future use of this modality. Free responses highlighted common perspectives on remote surgical gender care, including the increased accessibility of gender-affirming care through telehealth, the limitations of telehealth for addressing physical and relational aspects of gender care, patients' desire for autonomy and privacy during telehealth visits, and parents' desire to be involved throughout their children's gender journey. Conclusion These results demonstrate the unique ability of telemedicine, if implemented thoughtfully, to enhance outcomes for patients seeking surgical gender affirmation.
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Affiliation(s)
- Joseph A Martínez
- Department of Plastic and Oral Surgery, Center for Gender Surgery, Boston Children's Hospital, Boston, MA, USA
| | | | - Sangeeta Subedi
- Department of Plastic and Oral Surgery, Center for Gender Surgery, Boston Children's Hospital, Boston, MA, USA
| | - Elizabeth R Boskey
- Department of Plastic and Oral Surgery, Center for Gender Surgery, Boston Children's Hospital, Boston, MA, USA
- Department of Surgery, Harvard Medical School, Boston, MA, USA
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Oren Ganor
- Department of Plastic and Oral Surgery, Center for Gender Surgery, Boston Children's Hospital, Boston, MA, USA
- Department of Surgery, Harvard Medical School, Boston, MA, USA
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Kodjebacheva GD, Culinski T, Kawser B, Amin S. Satisfaction with pediatric telehealth according to the opinions of children and adolescents during the COVID-19 pandemic: A literature review. Front Public Health 2023; 11:1145486. [PMID: 37089475 PMCID: PMC10118045 DOI: 10.3389/fpubh.2023.1145486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 03/16/2023] [Indexed: 04/25/2023] Open
Abstract
Objective To review satisfaction with telehealth among children and adolescents based on their own opinions during the COVID-19 pandemic. Methods In the PubMed, CINAHL, PsycINFO, and Embase databases, we searched for peer-reviewed studies in English on satisfaction with telehealth among children and adolescents (rather than parents). Both observational studies and interventions were eligible. The review was categorized as a mini review because it focused on the limited time frame of the COVID-19 pandemic. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Reviewers extracted information from each study and assessed risk of bias. Results A total of 14 studies were eligible. Studies were conducted in Australia, Canada, Italy, Israel, Poland, South Korea, the United Kingdom, and the United States. They focused on a variety of health conditions. Two of the 14 studies were interventions. Participants expressed high satisfaction with video and telephone visits and home telemonitoring while also preferring a combination of in-person visits and telehealth services. Factors associated with higher satisfaction with telehealth included greater distance from the medical center, older age, and lower anxiety when using telehealth. In qualitative studies, preferred telehealth features among participants included: a stable Internet connection and anonymity and privacy during telehealth visits. Conclusion Telehealth services received favorable satisfaction ratings by children and adolescents. Randomized-controlled trials on the effectiveness of pediatric telehealth services compared to non-telehealth services may assess improvements in satisfaction and health outcomes.
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Affiliation(s)
- Gergana Damianova Kodjebacheva
- College of Health Sciences, University of Michigan-Flint, Flint, MI, United States
- Institute for Healthcare Policy and Innovation, University of Michigan-Ann Arbor, Ann Arbor, MI, United States
- *Correspondence: Gergana Damianova Kodjebacheva
| | - Taylor Culinski
- College of Health Sciences, University of Michigan-Flint, Flint, MI, United States
- Department of Behavioral Sciences, College of Arts and Sciences, University of Michigan-Flint, Flint, MI, United States
| | - Bushra Kawser
- College of Health Sciences, University of Michigan-Flint, Flint, MI, United States
| | - Saman Amin
- College of Health Sciences, University of Michigan-Flint, Flint, MI, United States
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19
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Olateju A, Cervantes M, Dowshen N, Kuhns LM, Dhar CP. Acceptability of Telemedicine Among Parents of Adolescent Patients in an Adolescent Clinic: Cross-sectional Survey Study. JMIR Pediatr Parent 2022; 5:e39704. [PMID: 36542447 PMCID: PMC9813812 DOI: 10.2196/39704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 11/08/2022] [Accepted: 11/09/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Since the beginning of the COVID-19 pandemic, new literature has described the perceptions of adolescent patients on the use of telemedicine for their health care, but less attention has been devoted to parents' and caregivers' perspectives on telemedicine usage for their adolescents. Parents' perspectives are important, as they undoubtedly influence how children learn to make decisions about their health care. OBJECTIVE This study describes the level of acceptability (measured based on accessibility and satisfaction) expressed by caregivers of adolescent patients with regard to telemedicine visits in an urban adolescent medicine practice. METHODS A cross-sectional survey was sent electronically to parents and guardians of patients aged <18 years who completed outpatient telemedicine visits to an adolescent medicine practice in Chicago, Illinois, from March 2020 to February 2021. The questions focused on accessibility and satisfaction. The data were analyzed to describe response frequencies. RESULTS Among a sample of 71 survey respondents, the vast majority reported that telemedicine was very easy to use (58/71, 82%) and was at least as convenient as in-person visits (70/71, 99%). Over 90% of respondents reported that their adolescents' needs were addressed (69/69, 100%) and that they were at least as comfortable with the level of privacy and the confidential conversations between their adolescents and medical providers in telemedicine visits (65/71, 92%) as they were with those in in-person visits. CONCLUSIONS Our findings suggest that parents and guardians find telemedicine to be an acceptable way for their children and adolescents to receive appropriate health care.
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Affiliation(s)
- Adetola Olateju
- Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Marbella Cervantes
- Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, IL, United States
| | - Nadia Dowshen
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States.,Craig-Dalsimer Division of Adolescent Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Lisa M Kuhns
- Northwestern University Feinberg School of Medicine, Chicago, IL, United States.,Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, IL, United States
| | - Cherie Priya Dhar
- Northwestern University Feinberg School of Medicine, Chicago, IL, United States.,Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, IL, United States
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Telehealth Care in a Pediatric and Adolescent Gynecology Clinic During the COVID-19 Pandemic. J Pediatr Adolesc Gynecol 2022; 36:280-283. [PMID: 36549464 PMCID: PMC9760611 DOI: 10.1016/j.jpag.2022.12.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 12/06/2022] [Accepted: 12/11/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Since the onset of the COVID-19 pandemic, health care systems have increased their telehealth services to meet the changing public health needs. Before the pandemic, telehealth was used primarily in surgical specialties for postoperative visits and rural medicine. However, out of necessity, nearly all medical and surgical subspecialties incorporated this virtual technology to improve patient health care access in a short time. Few studies have addressed telehealth in pediatric and adolescent gynecology (PAG) to date. STUDY OBJECTIVE To describe the large-scale utilization of telehealth visits, assess patient experience, and improve access to care in a large academic ambulatory gynecology PAG clinic METHODS: This retrospective, cross-sectional quality improvement study was performed by administering patient surveys and compiling aggregate data from the EPIC electronic health record in the Division of Pediatric and Adolescent Gynecology clinics at a single children's hospital between March 2020 and March 2021. Patient demographic characteristics, payer characteristics, visit type and purpose, and patient experience were reviewed. INTERVENTIONS Wider expansion of telehealth in PAG clinics at a single institution RESULTS: A total of 6159 telehealth appointments were performed, involving 6 clinic sites and 9 providers. Telehealth visits constituted 50% of the total ambulatory volume (12,527). Most patients were located within the institution's state (99.5%), and the remaining called into their telehealth visits from a neighboring state. Most patients were 18 years of age or younger (73%). Video visits lasted 15-30 minutes and included routine follow-up (66.3%), new/consult visits (28.4%), postoperative visits (1.6%), and urgent follow-up (0.2%). The patient population was ethnically diverse by self-identification: 61.4% White, 38.4% Hispanic, 16% Black, 4.4% Asian, and 0.4% Native Hawaiian/American Indian/Alaska Native. Payer mix included self-pay (45.5%), private payer (32.2%), and Medicaid/CHIP (22.3%). Conditions seen ranged from menstrual management (71%) and routine preventive or acute gynecologic concerns (21%) to surgical evaluation for congenital anomalies, endometriosis, fertility preservation, and genital concerns or pelvic masses (8%). Telehealth visits met patient expectations for 87.3% of respondents. Patient-reported opportunities for improvement included improving set-up instructions and more consistent audio/video connections. Challenges identified by providers included difficulty utilizing interpreters, technology limitations, and privacy constraints during HEADSS examination. CONCLUSIONS This study demonstrates how a large, diverse volume of patients with PAG needs received appropriate care through a telehealth format during the COVID-19 pandemic. Patients were satisfied with the services, but opportunities for improvement were elicited to allow for continued refining of this health care delivery tool in the future.
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Meyers RN, McHugh RB, Conde AM. Factors That Foster Therapeutic Alliance in Pediatric Sports and Orthopedics: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11813. [PMID: 36142080 PMCID: PMC9517398 DOI: 10.3390/ijerph191811813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 09/10/2022] [Accepted: 09/12/2022] [Indexed: 06/16/2023]
Abstract
Therapeutic alliance has been defined as building rapport between provider and patient in order to enhance patient motivation to improve outcomes. The purpose of this systematic review was to identify factors that patients look for that help build a strong therapeutic alliance in their pediatric sports or orthopedics healthcare provider, to identify if these factors differ across healthcare professions, and to identify any differences in therapeutic alliance between patients and their provider regarding in-person and telehealth visits. Scientific databases were searched from inception until August 2022. The search strategy resulted in 2195 articles with 11 studies included in the final analysis. The main attributes adolescents look for in their pediatric sports healthcare provider were shared decision making and understanding patients' sports and goals. These factors were found to differ among parents, sex, race, and socioeconomic status. The top factors improving therapeutic alliance in telehealth were having an already established relationship with the provider, visits lasting longer than 30 min, and having an English-speaking provider for English-speaking patients. The available literature highlights factors that contribute to the development of a stronger therapeutic alliance in the pediatric sports and orthopedics population. As these factors differ among adolescents, parents, sex, race, and socioeconomic status, this review provides insight in what patients and families look for in their provider when seeking care.
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Affiliation(s)
- Rachel N. Meyers
- Division of Occupational and Physical Therapy, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229, USA
| | - Robyn B. McHugh
- Division of Occupational and Physical Therapy, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229, USA
| | - Alissa M. Conde
- Division of Sports Medicine, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229, USA
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22
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Hatzikiriakidis K, West S, Ayton D, Morris H, Martin RS, Paraskeva M. When immunosuppression and COVID-19 intersect: An exploratory qualitative study of young lung transplant recipient perceptions of daily life during a pandemic. Pediatr Transplant 2022; 26:e14281. [PMID: 35427443 PMCID: PMC9115456 DOI: 10.1111/petr.14281] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 03/28/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND The COVID-19 pandemic poses an increased risk of infection, severe illness, hospitalization and mortality for young people who are immunosuppressed, including lung transplant (LTx) recipients. The aim of this study was to explore the intersection between immunosuppression and COVID-19, through the impacts of the pandemic upon the daily lives of young LTx recipients residing in the Australian state of Victoria. METHODS An exploratory qualitative research study was undertaken via consumer engagement. A purposive sample of 11 LTx recipients, residing in Victoria, was recruited during the first year of the COVID-19 pandemic. Semi-structured interviews were conducted to gain insights into their daily life and healthcare experiences, including the impacts of the COVID-19 pandemic. Data were interpreted using thematic analysis. RESULTS Four major themes were identified: (1) occupational deprivation due to the intersection of COVID-19 and lung transplant; (2) resilience and acceptance of restrictions; (3) infection control and vigilance about risk; and (4) care experiences of telehealth. CONCLUSIONS Occupational deprivation emerged as a common theme, specifically in the context of loss of access to meaningful everyday activities of developmental significance. However, participants also commonly reflected upon their ability to flexibly adjust to changing socially regulated community and healthcare environments. A high degree of acceptance and compliance with public health orders was self-reported, may be indicative of this cohort's long-term experience of chronic illness and their understanding of the importance of minimizing infection risks. Youth-informed healthcare strategies were identified as keystone to engaging them in institutional change and program adaptation during a pandemic.
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Affiliation(s)
- Kostas Hatzikiriakidis
- Health and Social Care UnitSchool of Public Health and Preventive MedicineFaculty of Medicine, Nursing, and Health SciencesMonash UniversityMelbourneVictoriaAustralia
| | - Simone West
- Department of Occupational TherapyNational Paediatric Lung‐Heart Transplant ServiceAlfred HealthMelbourneVictoriaAustralia
| | - Darshini Ayton
- Health and Social Care UnitSchool of Public Health and Preventive MedicineFaculty of Medicine, Nursing, and Health SciencesMonash UniversityMelbourneVictoriaAustralia
| | - Heather Morris
- Health and Social Care UnitSchool of Public Health and Preventive MedicineFaculty of Medicine, Nursing, and Health SciencesMonash UniversityMelbourneVictoriaAustralia
| | - Rani S. Martin
- Department of Allergy, Immunology, and Respiratory MedicineAlfred HospitalMonash UniversityMelbourneVictoriaAustralia
| | - Miranda Paraskeva
- Department of Allergy, Immunology, and Respiratory MedicineAlfred HospitalMonash UniversityMelbourneVictoriaAustralia,Central Clinical SchoolFaculty of Medicine, Nursing, and Health SciencesMonash UniversityMelbourneVictoriaAustralia
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Telehealth for contraceptive care: Lessons from staff and clinicians for improving implementation and sustainability in Illinois. Contracept X 2022; 4:100083. [PMID: 36060498 PMCID: PMC9436702 DOI: 10.1016/j.conx.2022.100083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 08/01/2022] [Accepted: 08/03/2022] [Indexed: 11/22/2022] Open
Abstract
Objective To solicit Illinois staff and clinician perspectives on rapid implementation of telehealth for contraceptive counseling and recommendations to improve and sustain it in the long term. Study design Researchers recruited and interviewed clinicians (n = 20) in primary care and obstetrics/gynecology clinics across 13 health care systems in Illinois, as well as clinicians (n = 11), leadership (n = 6) and staff (n = 7) from Planned Parenthood of Illinois clinics. Guided by the Consolidated Framework for Implementation Research, we coded and analyzed interview transcripts in Dedoose with a focus on themes regarding steps to improve quality and sustainability of telehealth. Results Participants expressed generally positive attitudes towards telehealth, noting that it increased access to care and time for patient education. Still, many highlighted areas of implementation that needed improvement. Clinic operations were complicated by gaps in telehealth training and the logistical needs of balancing telehealth and in-person appointments. Clinics had difficulty ensuring patient awareness of telehealth as an option for care, in addition to deficiencies with the telehealth technology itself. Finally, innovative resources for telehealth patients, while existent, have not been evenly offered across clinics. This includes the use of self-injection birth control, as well as providing medical equipment such as blood pressure cuffs in community settings. Some themes reflect issues specific to contraceptive counseling while others reflect issues with telehealth implementation in general, including confusion about reimbursement. Conclusion Illinois contraceptive care providers and staff wish to sustain telehealth for the long term, while also recommending specific improvements to patient communications, clinic operations, and access to supportive resources. Implications Our study highlights considerations for clinics to optimize implementation of telehealth services for contraceptive care. Providers described the value of clear workflows to balance in-person and telehealth visits, streamlined communications platforms, targeted patient outreach, training on providing virtual contraceptive care, and creative approaches to ensuring patient access to resources.
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